Tiny stories, big impact

Narrative medicine project connects residents

trainees and faculty gathered to the read the stories during an ice cream social.

“In 55 words or less, share a story about a time during residency that was humbling, stressful, relatable, rewarding or difficult. Include a photo.”

That’s the prompt Marissa LoCastro, MD, PG-2, sent to her fellow residents, attending faculty, and fellows across the University of Wisconsin Department of Medicine (UW DOM) this spring, as part of a project called Tiny Story. 

The 57 stories she collected express the full range of the trainee experience: bleak, funny, heartfelt, grieving, frustrated, mundane, absurd. 

Each was printed, laminated and recently displayed at an ice cream social for DOM faculty and trainees.

“People have told me that they've enjoyed them because they carry so many of the same stories,” Dr. LoCastro says. “And that’s the whole premise of the project. Stories connect us better than anything else.”

Stories connect us better than anything else.

Marissa LoCastro, MD

She elaborates in the video below.

Compassion and communication

Early in her first year of residency, Dr. LoCastro encountered an angry patient. Angry with her. “I left and immediately started thinking I was the worst doctor ever,” she recalls. 

But she quickly realized she wasn’t alone.

“We’re always internalizing the things that happen to us as residents. Unless someone else is willing to say it happens to them, too, it must only happen to us.”

So she created the Tiny Story project, drawing inspiration from narrative medicine techniques learned in medical school and funding from a David Sunde Humanitarian Award (given annually to one or more internal medicine residents pursuing projects that enrich humanism among DOM learners).

We’re always internalizing the things that happen to us as residents. Unless someone else is willing to say it happens to them, too, it must only happen to us.

Dr. LoCastro

The project is an excellent example of how humanities-based techniques can foster compassion and communication in graduate medical education. 

“I hope that part of the takeaway for the residents was to offer themselves the same compassion they offer to their patients and colleagues,” adds Abigail Mapes, MA, graduate medical education program manager.

Faculty engagement

While roughly 60% of the stories came from other residents (and one fellow), plenty came from faculty—including from the program’s director, Andy Coyle, MD, associate professor, General Internal Medicine, and from Department Chair Lynn Schnapp, MD, George R. and Elaine Love Professor.

“A lot of residents commented on how impactful it was for someone so high in our leadership to write something vulnerable,” Dr. LoCastro notes. “We don’t get to talk to our attendings about this kind of stuff. We just see them in these successful roles.”

For faculty, too, the stories can be an evocative, edifying trip down memory lane.

“They reminded me of how stressful, humbling, sometimes ridiculous, and nonetheless wonderful it is to be a physician, particularly during those formative years,” says Elizabeth Chapman, MD, clinical associate professor, Geriatrics and Gerontology. “I’m very grateful for the effort Dr. LoCastro put into collecting them and creating a venue to share them.”

They reminded me of how stressful, humbling, sometimes ridiculous, and nonetheless wonderful it is to be a physician, particularly during those formative years.

Elizabeth Chapman, MD

Image
Dr. Chapman (center) enjoying the ice cream social with Dr. LoCastro (left) and Abigail Mapes, MA, who helped organize the event.

Where to read

The stories will be gathered and bound in a book for the residency library in University Hospital. 

Banner: trainees and faculty gathered to read the stories during an ice cream social. Photo and video credit: Clint Thayer/Department of Medicine.

A paved path under a garden arch at dusk.

"I fear time may be shorter than we expected. I'm worried your loved one may die tonight." Words no amount of training makes easier to say.

His sister arrives within the hour. I ask her about her brother—his interests, his quirks

Despite so much tragedy and grief she responds, "Thank you for being so kind."

Field at dusk

I am so behind in clinic.

My patient, a sweet older lady I've been caring for the past three years speaks about her childhood traumas.  

She leaves with a warm hug as this is our last visit before I graduate, and I realize that I needed that hug just as much as she did.

Cars driving down a very curvy road

"Are you currently having chest pain?"

**5 minutes later**

"...this was back in 1986 - or 87? - at a softball game. Big Jim could pitch 'em fast and when I was up he popped me right *here* on the shoulder, real good.

So that's why I sleep on my right side."

"No chest pain, got it."

A black cat sniffing a physician's pager

The cross-covering team has arrived and I sign out my patients. 

I triumphantly drive home after finishing my last call shift of the rotation. 

 get inside and remove my coat, but my heart sinks as I discover the code pager in my pocket.

Cats can run codes, right?

Two jet flying through a blue sky with their contrails crossing.

"I haven't had a BM in weeks! I've tried everything they've given me and nothing works. Last time they made me drink a gallon of colon prep."

"Wait, you drank colon prep and nothing came out?"

"No, a ton came out, but it was all liquid. All l ever have is liquid stools. I haven't had a real BM in weeks. I keep telling you guys that."

Clock

I was on call Saturday night at the VA when two early morning transfer requests came in.

I happily accepted them, knowing that my shift would be over when they arrived. When the page comes, I smugly reply that I am no longer on call. 

The nurse kindly explains that daylight savings time just ended and l'm still on duty.

Empty orange and yellow seats in a New York City subway car.

A man saw her pregnant belly and stood up. I looked over - people didn't always offer a seat. 

My eyes scanned upward and saw a distended belly, slender arms. Then, a gaunt face. Then, temporal wasting, jaundice, icterus. Not pregnancy, ascites.

I realized, I see differently now.

I see like a doctor and can't un-see.

A sandy beach at sunset.

I'm a new intern on a busy month of wards and my inbox is bursting with MyChart messages that I'm too stressed to open. 

I recognize one patient's name, a young woman who was struggling with infertility and hypertension. I click on it. 

She had no medical questions, just a brief note to share that she was pregnant.

She wanted me to hear her good news.

A blue-footed booby standing on sandy, uncertain ground.

I remember my first time being paged to pronounce a patient dead. 

I stood there, heart pounding—unsure, awkward, overwhelmed. If I didn't say it, were they still alive? What if I was wrong?

It was humbling—medicine's surreal collision of life, death, and the uncertain space in between.

An AI-generated image of a bottle of statin medication next to a slice of pizza.

Me: "So, have you any allergies?" 

Little old lady: "Yes, statins..."

Me: "OK, what do those do?"

Little old lady: "They're for cholesterol, doctor."

Oh, THOSE statins.